Insights

CMS Announces a Six-Month Extension of the Medicare Enrollment Moratoria for Home Health Agencies

Posted on Thursday, August 4, 2016 3:33 PM

CMS announced a six-month extension of the temporary moratoria on the new Medicare home health agencies (HHAs), subunits, and branch locations within the following states: Florida, Illinois, Michigan and Texas. Additionally, the moratoria will apply to Medicaid and the Children’s Health Insurance Program (CHIP) in each state.

CMS has outlined the following high risk factors that are needed to implement the temporary moratoria: fraud, waste and abuse. Therefore, CMS has an understanding that a high risk of fraud, waste, or abuse exists because of the avoidance of the moratoria by some providers.

However, the policy does not apply to the following changes:• Changes in practice locations• Changes to provider or supplier information such as phone number, address, or changes in ownership, except changes in ownership of HHAs that require initial enrollments

CMS is aware of providers that have dedicated years of hard work and thousands of dollars to prepare for Medicare enrollment – only to have the application denied due to the hassle of a moratorium.

This policy position is intimidating, especially since CMS proposed to change when a moratoria would apply to new enrollment applicants in the March 1, 2016, proposed rule (81 FR 10720) titled “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process.” In that proposed rule CMS stated the following:

“Section 424.570(a) (1)(iv) currently states that a temporary enrollment moratorium does not apply to any enrollment application that has been approved by the enrollment contractor but not yet entered into PECOS at the time the moratorium is imposed. We propose to revise this paragraph to state that a temporary moratorium does not apply to any enrollment application that has been received by the Medicare contractor prior to the date the moratorium is imposed.”